FutureMS cohort profile: a Scottish multicentre inception cohort study of relapsing-remitting multiple sclerosis.

PURPOSE: Multiple sclerosis (MS) is an immune-mediated, neuroinflammatory disease of the central nervous system and in industrialised countries is the most common cause of progressive neurological disability in working age persons. While treatable, there is substantial interindividual heterogeneity in disease activity and response to treatment. Currently, the ability to predict at diagnosis who will have a benign, intermediate or aggressive disease course is very limited. There is, therefore, a need for integrated predictive tools to inform individualised treatment decision making. PARTICIPANTS: Established with the aim of addressing this need for individualised predictive tools, FutureMS is a nationally representative, prospective observational cohort study of 440 adults with a new diagnosis of relapsing-remitting MS living in Scotland at the time of diagnosis between May 2016 and March 2019. FINDINGS TO DATE: The study aims to explore the pathobiology and determinants of disease heterogeneity in MS and combines detailed clinical phenotyping with imaging, genetic and biomarker metrics of disease activity and progression. Recruitment, baseline assessment and follow-up at year 1 is complete. Here, we describe the cohort design and present a profile of the participants at baseline and 1 year of follow-up. FUTURE PLANS: A third follow-up wave for the cohort has recently begun at 5 years after first visit and a further wave of follow-up is funded for year 10. Longer-term follow-up is anticipated thereafter.

[Post-COVID-19 syndrome: epidemiology, diagnostic criteria and pathogenic mechanisms involved]. / Síndrome post-COVID-19: epidemiología, criterios diagnósticos y mecanismos patogénicos implicados.

INTRODUCTION: Many patients with mild or severe COVID-19 do not make a full recovery and have a wide range of chronic symptoms for weeks or months after infection, often of a neurological, cognitive or psychiatric nature. The epidemiological evidence, diagnostic criteria and pathogenesis of post-COVID-19 syndrome are reviewed. DEVELOPMENT: Post-COVID-19 syndrome is defined by persistent clinical signs and symptoms that appear while or after suffering COVID-19, persist for more than 12 weeks and cannot be explained by an alternative diagnosis. The symptoms can fluctuate or cause relapses. It is a heterogeneous condition that includes post-viral chronic fatigue syndrome, sequelae in multiple organs and the effects of severe hospitalisation/post-intensive care syndrome. It has been reported in patients with mild or severe COVID-19 and irrespective of the severity of the symptoms in the acute phase. Between 10% and 65% of survivors who had mild/moderate COVID-19 present symptoms of post-COVID-19 syndrome for 12 weeks or more. At six months, subjects report an average of 14 persistent symptoms. The most common symptoms are fatigue, dyspnoea, anxiety, depression, and impaired attention, concentration, memory and sleep. The underlying biological mechanisms are unknown, although an abnormal or excessive autoimmune and inflammatory response may play an important role. CONCLUSIONS: Clinical manifestations are diverse, fluctuating and variable, although fatigue and neurocognitive complaints predominate. There is no defined consensus on post-COVID-19 syndrome and its diagnostic criteria have not been subjected to adequate psychometric evaluation.

TITLE: Síndrome post-COVID-19: epidemiología, criterios diagnósticos y mecanismos patogénicos implicados.Introducción. Numerosos pacientes con COVID-19 leve o grave no tienen una recuperación completa y presentan una gran variedad de síntomas crónicos durante semanas o meses tras la infección, con frecuencia de carácter neurológico, cognitivo o psiquiátrico. Se revisan las evidencias epidemiológicas, los criterios diagnósticos y la patogenia del síndrome post-COVID-19. Desarrollo. El síndrome post-COVID-19 se define por la persistencia de signos y síntomas clínicos que surgen durante o después de padecer la COVID-19, permanecen más de 12 semanas y no se explican por un diagnóstico alternativo. Los síntomas pueden fluctuar o causar brotes. Es una entidad heterogénea que incluye el síndrome de fatiga crónica posvírica, la secuela de múltiples órganos y los efectos de la hospitalización grave/síndrome poscuidados intensivos. Se ha descrito en pacientes con COVID-19 leve o grave y con independencia de la gravedad de los síntomas en la fase aguda. Un 10-65% de los supervivientes que padeció COVID-19 leve/moderada presenta síntomas de síndrome post-COVID-19 durante 12 semanas o más. A los seis meses, los sujetos relatan un promedio de 14 síntomas persistentes. Los síntomas más frecuentes son fatiga, disnea, alteración de la atención, de la concentración, de la memoria y del sueño, ansiedad y depresión. Se desconocen los mecanismos biológicos que subyacen, aunque una respuesta autoinmunitaria e inflamatoria anómala o excesiva puede tener un papel importante. Conclusiones. Las manifestaciones clínicas son diversas, fluctuantes y variables, aunque predominan la fatiga y las quejas neurocognitivas. No existe un consenso definido sobre el síndrome post-COVID-19 y sus criterios diagnósticos no se han sometido a una evaluación psicométrica adecuada.

Epidemiology, pathophysiology, and classification of the neurological symptoms of post-COVID-19 syndrome.

Introduction: Post-COVID-19 syndrome is a series of chronic signs and symptoms that may appear after SARS-CoV-2 infection, including fatigue, dyspnoea, chest pain, palpitations, anxiety, depression, and joint and muscle pain. The purpose of this study was to review the controversies on post-COVID-19 syndrome, the frequency of neurological symptoms, and the potential pathophysiological mechanisms. Methods: We present a narrative review of studies published in PubMed since the beginning of the pandemic (January 2020-July 2021). Results: Patients with history of COVID-19 have been found to present persistent neurological symptoms, including cognitive complaints, memory and concentration problems, headache, anosmia, ageusia, vertigo, and insomnia. Post-COVID-19 syndrome is a heterogeneous disease that lacks a universally accepted definition, which may explain the great variability in the estimated prevalence (2.3%-85%) and symptom duration. The criteria differentiating post-COVID-19 syndrome from chronic fatigue syndrome or critical illness syndrome are ambiguous. Risk factors include older age, female sex, certain comorbidities, and greater number of symptoms in the acute phase. The pathophysiology of the syndrome is largely unknown, although it is probably multifactorial, including immunological mechanisms, neural network dysfunction, neurotransmitter alterations, persistent viral damage, and functional impairment. Conclusions: Post-COVID-19 syndrome may present after mild or even asymptomatic SARS-CoV-2 infection, causing limitations in activities of daily living and in quality of life. Further research will clarify the origin and most appropriate management of these neurological alterations.

Introducción: El término "síndrome post-COVID" se emplea para describir una serie de signos y síntomas crónicos que pueden surgir tras la infección por el virus SARS-CoV-2, como fatiga, disnea, dolor torácico, palpitaciones, ansiedad, depresión, dolores articulares y musculares entre otros. El objetivo es revisar las controversias asociadas al síndrome post-COVID-19, la frecuencia de los síntomas neurológicos y su posible fisiopatología. Métodos: Revisión narrativa crítica de los estudios publicados desde el inicio de la pandemia en pubmed (enero 2020 a julio 2021). Resultados: Síntomas neurológicos persistentes (quejas cognitivas, problemas de memoria y concentración; cefalea, anosmia, ageusia, vértigo, insomnio, etc) se han descrito en personas que padecieron COVID-19. El síndrome post-COVID-19 no es una entidad homogénea y no tiene una definición universalmente aceptada, lo que explica la variación en las estimaciones sobre prevalencia (2,3%­85%) y duración de los síntomas. Los criterios que lo distinguen del síndrome de fatiga crónica o el síndrome del paciente crítico son ambiguos. Los factores de riesgo incluyen edad, sexo (mujer), comorbidades, y número de síntomas en la fase aguda. La fisiopatología es en gran medida desconocida, pero probablemente multifactorial, incluyendo mecanismos inmunológicos, disfunción de redes neuronales y alteración de neurotransmisores, daño viral persistente, y cuadros de origen funcional, entre otros. Conclusiones: Los síntomas post-COVID-19 pueden surgir tras padecer una infección leve o incluso asintomática, y causa limitaciones en las actividades de la vida diaria y calidad de vida. El progreso en la investigación nos ayudará a aclarar el origen y manejo de estas complejas alteraciones neurológicas.

Neurological complications of coronavirus and COVID-19. / Complicaciones neurológicas por coronavirus y COVID-19.

INTRODUCTION: Clinical and experimental studies have shown that the coronavirus family has a certain tropism for the central nervous system. Seven types of coronavirus can infect humans. DEVELOPMENT: Coronaviruses are not always confined to the respiratory tract, and under certain conditions they can invade the central nervous system and cause neurological pathologies. The potential for neuroinvasion is well documented in most human coronaviruses (OC-43, 229E, MERS and SARS) and in some animal coronaviruses (porcine haemagglutinating encephalomyelitis coronavirus). Neurological symptoms have been reported in patients affected by COVID-19, such as headache, dizziness, myalgia and anosmia, as well as cases of encephalopathy, encephalitis, necrotising haemorrhagic encephalopathy, stroke, epileptic seizures, rhabdomyolysis and Guillain-Barre syndrome, associated with SARS-CoV-2 infection. CONCLUSIONS: Future epidemiological studies and case records should elucidate the real incidence of these neurological complications, their pathogenic mechanisms and their therapeutic options.

TITLE: Complicaciones neurológicas por coronavirus y COVID-19.Introducción. Estudios clínicos y experimentales han demostrado que la familia de los coronavirus tiene un cierto tropismo por el sistema nervioso central. Siete tipos de coronavirus pueden contagiar al ser humano. Desarrollo. Los coronavirus no siempre permanecen confinados en el tracto respiratorio, y en determinadas condiciones pueden invadir el sistema nervioso central y causar patologías neurológicas. La capacidad potencial de neuroinvasión está bien documentada en la mayor parte de los coronavirus humanos (OC-43, 229E, MERS y SARS) y en algunos coronavirus animales (coronavirus de la encefalomielitis hemaglutinante porcina). Se han descrito síntomas neurológicos en pacientes afectos por COVID-19, como cefalea, mareo, mialgias y anosmia, así como casos de encefalopatía, encefalitis, encefalopatía necrotizante hemorrágica, ictus, crisis epilépticas, rabdomiólisis y síndrome de Guillain-Barré, asociados a la infección por el SARS-CoV-2. Conclusiones. Futuros estudios epidemiológicos y registros de casos deben elucidar la incidencia real de estas complicaciones neurológicas, sus mecanismos patogénicos y sus opciones terapéuticas.

[Neurological complications associated with dengue virus infection]. / Complicaciones neurologicas asociadas a la infeccion por el virus del dengue.

INTRODUCTION: Dengue is an arboviral infection caused by the dengue virus. The neurological complications associated with this infection are reviewed. DEVELOPMENT: The neurotropic nature of dengue virus has been confirmed in epidemiological studies, case series and histopathological studies. The range of neurological complications is 5.6-14.6%, and they are more frequent in serotypes 1 and 3. Encephalopathy is the most common neurological syndrome (0.5-6%) and its prevalence is higher in children and adolescents. The detection of the viral antigen in brain tissue and the presence of pleocytosis or RNA in cerebrospinal fluid are evidence of the neurotropic nature of dengue virus, which manifests itself in the form of encephalitis. Neurological syndromes during convalescence (disseminated acute cerebellitis, opsoclonus-myoclonus syndrome, mononeuritis, poly-radiculoneuritis and plexitis) appear to be immunomediated. Myelitis can occur during acute dengue virus infection and through an immunomediated mechanism in the convalescence phase. Myalgias, myositis, rhabdomyolysis and hypokalemic paralysis are examples of muscular dysfunction associated with the dengue virus. The incidence of stroke is 0.26%, and may be ischaemic or haemorrhagic. Ophthalmological complications include maculopathy, retinal haemorrhage, optic neuropathy and vitritis. CONCLUSIONS: The spectrum of neurological complications from dengue virus is broad. There are no reliable data on its real incidence because most of the studies published to date are isolated series or cases.

TITLE: Complicaciones neurologicas asociadas a la infeccion por el virus del dengue.Introduccion. El dengue es una infeccion arboviral causada por el virus del dengue. Se revisan las complicaciones neurologicas asociadas a dicha infeccion. Desarrollo. El caracter neurotropo del virus del dengue se ha confirmado en estudios epidemiologicos, series de casos y estudios histopatologicos. El rango de complicaciones neurologicas es del 5,6-14,6%, y son mas frecuentes en los serotipos 1 y 3. La encefalopatia es el sindrome neurologico mas comun (0,5-6%); su prevalencia es mayor en los niños y los adolescentes. La deteccion del antigeno viral en el tejido cerebral y la presencia de pleocitosis o ARN en el liquido cefalorraquideo son evidencia del caracter neurotropo del virus del dengue, que se manifiesta en forma de encefalitis. Los sindromes neurologicos durante la fase de convalecencia (encefalomielitis aguda diseminada, cerebelitis, opsoclonia-mioclonia, mononeuritis, polirradiculoneuritis y plexitis) parecen ser inmunomediados. La mielitis puede suceder durante la infeccion aguda por el virus del dengue y por un mecanismo inmunomediado en la fase de convalecencia. Mialgias, miositis, rabdomiolisis y paralisis hipopotasemica son ejemplos de disfuncion muscular asociada al virus del dengue. La incidencia de ictus es del 0,26%, y puede ser isquemico o hemorragico. Las complicaciones oftalmologicas incluyen maculopatia, hemorragia retiniana, neuropatia optica y vitritis. Conclusiones. El espectro de complicaciones neurologicas por el virus del dengue es amplio. No existen datos fiables sobre su incidencia real porque la mayor parte de los estudios publicados son series o casos aislados.

Hallucinogenic drugs in pre-Columbian Mesoamerican cultures.

INTRODUCTION: The American continent is very rich in psychoactive plants and fungi, and many pre-Columbian Mesoamerican cultures used them for magical, therapeutic and religious purposes. OBJECTIVES: The archaeological, ethno-historical and ethnographic evidence of the use of hallucinogenic substances in Mesoamerica is reviewed. RESULTS: Hallucinogenic cactus, plants and mushrooms were used to induce altered states of consciousness in healing rituals and religious ceremonies. The Maya drank balché (a mixture of honey and extracts of Lonchocarpus) in group ceremonies to achieve intoxication. Ritual enemas and other psychoactive substances were also used to induce states of trance. Olmec, Zapotec, Maya and Aztec used peyote, hallucinogenic mushrooms (teonanacatl: Psilocybe spp) and the seeds of ololiuhqui (Turbina corymbosa), that contain mescaline, psilocybin and lysergic acid amide, respectively. The skin of the toad Bufo spp contains bufotoxins with hallucinogenic properties, and was used since the Olmec period. Jimson weed (Datura stramonium), wild tobacco (Nicotiana rustica), water lily (Nymphaea ampla) and Salvia divinorum were used for their psychoactive effects. Mushroom stones dating from 3000 BC have been found in ritual contexts in Mesoamerica. Archaeological evidence of peyote use dates back to over 5000 years. Several chroniclers, mainly Fray Bernardino de Sahagún, described their effects in the sixteenth century. CONCLUSIONS: The use of psychoactive substances was common in pre-Columbian Mesoamerican societies. Today, local shamans and healers still use them in ritual ceremonies in Mesoamerica.

High-altitude headache and acute mountain sickness.

INTRODUCTION: Headache is the most common complication associated with exposure to high altitude, and can appear as an isolated high-altitude headache (HAH) or in conjunction with acute mountain sickness (AMS). The purpose of this article is to review several aspects related to diagnosis and treatment of HAH. DEVELOPMENT: HAH occurs in 80% of all individuals at altitudes higher than 3000 meters. The second edition of ICHD-II includes HAH in the chapter entitled "Headaches attributed to disorder of homeostasis". Hypoxia elicits a neurohumoral and haemodynamic response that may provoke increased capillary pressure and oedema. Hypoxia-induced cerebral vasodilation is a probable cause of HAH. The main symptom of AMS is headache, frequently accompanied by sleep disorders, fatigue, dizziness and instability, nausea and anorexia. Some degree of individual susceptibility and considerable inter-individual variability seem to be present in AMS. High-altitude cerebral oedema is the most severe form of AMS, and may occur above 2500 meters. Brain MRI studies have found variable degrees of oedema in subcortical white matter and the splenium of the corpus callosum. HAH can be treated with paracetamol or ibuprofen. Pharmacological treatment of AMS is intended to increase ventilatory drive with drugs such as acetazolamide, and reduce inflammation and cytokine release by means of steroids. CONCLUSIONS: Symptom escalation seems to be present along the continuum containing HAH, AMS, and high-altitude cerebral oedema.

[Skull cult. Trophy heads and tzantzas in pre-Columbian America]. / El culto a los craneos. Cabezas trofeo y tzantzas en la America precolombina.

INTRODUCTION: The skull cult is a cultural tradition that dates back to at least Neolithic times. Its main manifestations are trophy heads, skull masks, moulded skulls and shrunken heads. The article reviews the skull cult in both pre-Columbian America and the ethnographic present from a neuro-anthropological perspective. DEVELOPMENT: The tradition of shaping and painting the skulls of ancestors goes back to the Indo-European Neolithic period (Natufian culture and Gobekli Tepe). In Mesoamerica, post-mortem decapitation was the first step of a mortuary treatment that resulted in a trophy head, a skull for the tzompantli or a skull mask. The lithic technology utilised by the Mesoamerican cultures meant that disarticulation had to be performed in several stages. Tzompantli is a term that refers both to a construction where the heads of victims were kept and to the actual skulls themselves. Skull masks are skulls that have been artificially modified in order to separate and decorate the facial part; they have been found in the Templo Mayor of Tenochtitlan. The existence of trophy heads is well documented by means of iconographic representations on ceramic ware and textiles belonging to the Paraca, Nazca and Huari cultures of Peru. The Mundurucu Indians of Brazil and the Shuar or Jivaroan peoples of Amazonian Ecuador have maintained this custom down to the present day. The Shuar also shrink heads (tzantzas) in a ritual process. Spanish chroniclers such as Fray Toribio de Benavente 'Motolinia' and Gaspar de Carvajal spoke of these practices. CONCLUSIONS: In pre-Columbian America, the tradition of decapitating warriors in order to obtain trophy heads was a wide-spread and highly developed practice.

Dementia associated with Parkinson's disease: applying the Movement Disorder Society Task Force criteria.

BACKGROUND: Diagnostic criteria and procedures for dementia in Parkinson's disease (PDD) have been proposed by a Movement Disorders Society Task Force (MDS-TF). The objective of this study was to explore the utility of the new MDS-TF criteria and procedures in clinical practice. METHODS: Two hundred ninety nine PD patients (36.5% with PDD as per MDFS-TF criteria; 33.1% according the DSM-IV) were included in the study. A variety of standardized motor, cognitive, psychiatric, and global severity measures were administered. A multivariate logistic regression model was built to determine the variables producing discrepancy between the MDS-TF and DSM-IV criteria for PDD and the clinical features that distinguished false negative cases. RESULTS: Agreement between MDS-TF and DSM-IV criteria was substantial (87.3%; kappa = 0.72), but the DSM-IV criteria failed to identify 22% of patients fulfilling MDS-TF criteria. False negative cases were older and had more severe motor symptoms but less psychosis than those true non-demented PD. False positives had less severe motor symptoms than true PDD, although the difference did not reach statistical significance. CONCLUSIONS: Our findings suggest that the MDS-TF criteria are more sensitive than the DSM-IV for a diagnosis of PDD. Old age, absence of psychiatric symptoms, and severe motor impairment can hinder the diagnosis of PDD.

Metric properties of the Spanish version of the Lake Louise Acute Mountain Sickness Questionnaire.

OBJECTIVES: To assess the metric properties of the Lake Louise Acute Mountain Sickness (LLAMSQ) five-item questionnaire. METHODS: At the end of the course "Neuroscience in pre-Columbian Andean cultures" (Peru, 2009), the participants answered the self-reported version of the LLAMSQ. The following psychometric attributes were explored: acceptability (observed versus possible scores; floor and ceiling effects), scaling assumptions (item-total correlation > 0.30), internal consistency (Cronbach́s alpha), precision (standard error of measurement), and convergent and discriminative validity. Differences in mean score of LLAMSQ between symptomatic acute mountain sickness subjects and asymptomatic ones were calculated. RESULTS: The participants stayed for days at Cuzco (3,400 meters above sea level, MASL), Sacred valley (2,850 MASL) and Machu Picchu (2,450 MASL). Seventy people (60% males; mean age 50±8 years; 88.6% neurologists) were included in the study. LLAMSQ mean score was 3.36±2.02 (median 3; skewness 0.61). Ceiling and floor effects were 7.3% and 1.4%, respectively. Cronbach́s alpha was 0.61, and standard error of measurement 1.26. LLAMSQ mean score significantly correlated (r=0.41, P=.002) with physical items (ataxia, dyspnoea, tremor, mental symptoms). LLAMSQ mean scores were significantly higher (worse) in those subjects who presented with acute sickness mountain (5.8 vs 3.0; Mann-Whitney, P<.0001). CONCLUSIONS: Metric properties of the LLASMQ Spanish version are adequate. This questionnaire seems to be useful in the early detection of high-altitude illness.

International study on the psychometric attributes of the non-motor symptoms scale in Parkinson disease.

BACKGROUND: Nonmotor symptoms (NMS) have a great impact on patients with Parkinson disease (PD). The Non-Motor Symptoms Scale (NMSS) is an instrument specifically designed for the comprehensive assessment of NMS in patients with PD. NMSS psychometric properties have been tested in this study. METHODS: Data were collected in 12 centers across 10 countries in America, Asia, and Europe. In addition to the NMSS, the following measures were applied: Scales for Outcomes in Parkinson's Disease (SCOPA)-Motor, SCOPA-Psychiatric Complications (SCOPA-PC), SCOPA-Cognition, Hoehn and Yahr Staging (HY), Clinical Impression of Severity Index for Parkinson's Disease (CISI-PD), SCOPA-Autonomic, Parkinson's Disease Sleep Scale (PDSS), Parkinson's Disease Questionnaire-39 items (PDQ-39), and EuroQol-5 dimensions (EQ-5D). NMSS acceptability, reliability, validity, and precision were analyzed. RESULTS: Four hundred eleven patients with PD, 61.3% men, were recruited. The mean age was 64.5 +/- 9.9 years, and mean disease duration was 8.1 +/- 5.7 years. The NMSS score was 57.1 +/- 44.0 points. The scale was free of floor or ceiling effects. For domains, the Cronbach alpha coefficient ranged from 0.44 to 0.85. The intraclass correlation coefficient (0.90 for the total score, 0.67-0.91 for domains) and Lin concordance coefficient (0.88) suggested satisfactory reproducibility. The NMSS total score correlated significantly with SCOPA-Autonomic, PDQ-39, and EQ-5D (r(S) = 0.57-0.70). Association was close between NMSS domains and the corresponding SCOPA-Autonomic domains (r(S) = 0.51-0.65) and also with scales measuring related constructs (PDSS, SCOPA-PC) (all p < 0.0001). The NMSS total score was higher for women (p < 0.02) and for increasing disease duration, HY, and CISI-PD severity level (p < 0.001). The SEM was 13.91 for total score and 1.71 to 4.73 for domains. CONCLUSION: The Non-Motor Symptoms Scale is an acceptable, reproducible, valid, and precise assessment instrument for nonmotor symptoms in Parkinson disease.

[Tropical causes of epilepsy]. / Causas tropicales de epilepsia.

INTRODUCTION: Eighty-five percent of all epileptics live in tropical regions. Prenatal risk factors, traumatic brain injuries and different parasitic infestations of the central nervous system (CNS) are the reasons behind the high prevalence of epilepsy. This work reviews the main parasitic infestations causing epilepsy in the tropics. DEVELOPMENT: Neurocysticercosis is the main cause of focal epilepsy in early adulthood in endemic areas (30-50%). All the phases of cysticerci (viable, transitional and calcified) are associated with epileptic seizures. Anti-cysticercus treatment helps get rid of cysticerci faster and reduces the risk of recurrence of seizures in patients with viable cysts. Symptomatic epilepsy can be the first manifestation of neuroschistosomiasis in patients without any systemic symptoms. The pseudotumoral form can trigger seizures secondary to the presence of granulomas and oedemas in the cerebral cortex. The eggs of Schistosoma japonicum are smaller, reach the CNS more easily and trigger epileptic seizures more frequently. Toxocariasis and sparganosis are other parasitic infestations that can give rise to symptomatic seizures. The risk factors for suffering chronic epilepsy after cerebral malaria are a positive familial history of epilepsy and a history of episodes of fever and cerebral malaria that began with coma or which progressed with multiple, prolonged epileptic seizures. About 20% of patients with cerebral infarction secondary to Chagas disease present late vascular epilepsy as a complication. CONCLUSIONS: Very few studies have been conducted to examine the prognosis, risk of recurrence and modification of the natural course of seizures associated with tropical parasitic infestations, except for the case of neurocysticercosis.

[Aetiology of epileptic seizures in a rehabilitation centre]. / Etiología de las crisis epilépticas en un centro de rehabilitación.

INTRODUCTION: Epileptic seizures are a common complication among patients who are admitted to rehabilitation hospitals. This work examines aspects related to their aetiology and progress. PATIENTS AND METHODS: The study involved all the patients with a history of epileptic seizures who had been consecutively admitted for rehabilitation during the second semester of 2008. The protocol for data collection included sociodemographic variables, the aetiology, type, frequency and complications of the seizures, and their treatment and side effects. RESULTS: An analysis was performed on 160 patients (62.5% males; mean age: 43.6 years). The main aetiologies were the following: stroke (41.2%), traumatic brain injury (35%), meningitis/encephalitis (5%), primary brain tumour (3.8%), anoxia (3.8%), static encephalopathy (3.8%) and others (7.6%). 7.6% had a history of epilepsy before suffering the brain injury. 16.3% had had a single epileptic seizure. 6.2% presented treatment failure with two antiepileptic drugs, and 12.5% suffered from more than one seizure per month. 17.5% of the patients had suffered from an epileptic status. In semiological terms, the most common seizures were focal seizures (54.5%), generalised seizures (44.4%) and focal seizures with secondary generalisation (31.9%). 76% of the subjects took antiepileptic drugs on a regular basis, but the caregiver was responsible for medication in 70% of cases. Carbamazepine and valproate were the two most frequently used drugs. CONCLUSIONS: Epilepsy can limit rehabilitation therapy in patients with stroke or traumatic injury, due to the risk of developing difficult-to-treat epilepsy. Caregivers often have to take responsibility for the pharmacological treatment in disabled patients with brain damage.

[Neurological aspects described in The treasure of medicines for all illnesses by Gregorio López]. / Aspectos neurológicos descritos en El tesoro de medicinas para todas enfermedades, de Gregorio López.

INTRODUCTION: Latin American medicine in the 16th century produced the first collections of herbs with native plants from the New World. Treatises on popular therapies appeared, which included gallenic remedies as well as incorporating autochthonous plants. We review the main neurological diseases and their treatments described in The Treasure of Medicines for All Illnesses by Gregorio Lopez (1542-1596). DEVELOPMENT: Some critics claim that his work was an enumeration of empirical prescriptions, sometimes with a magico-religious influence, which was extended in successive reprints. Yet, this manuscript is probably the first treatise on therapeutics written by a European in the New World to describe the native remedies employed in the treatment of diseases. In the section entitled Remedies in alphabetical order the following neurological ailments and appropriate remedies to treat them are described: abscess, apoplexy, brain, chilling, cramp, gota coral or epilepsy, headache, melancholy, memory, migraine, nerves, palsy, paralysis, sciatica, stupor and vertigo. The list of diseases is very complete and includes syndromes ranging from fevers, colics and bruises to phthisis, scabs or burns. The copy of the manuscript in the Vatican contains a final section on Indian medicines, which includes a list of medicinal plants used at that time, with the names given in Nahuatl language. CONCLUSIONS: Headaches, epilepsy and conditions affecting the peripheral nerves were the neurological pathologies that were described at greatest length in The Treasure of Medicines for All Illnesses, and for which a greater number of natural prescriptions were compiled.

[Immunopathogenesis and treatment of the myelopathy associated to the HTLV-I virus]. / Inmunopatogenesis y tratamiento de la mielopatia asociada al virus linfotropico humano de celulas T (HTLV-I).

INTRODUCTION: Human T-cell lymphotropic virus type-I (HTLV-I) causes tropical spastic paraparesis/HTLV-I associated myelopathy (TSP/HAM). Immunopathogenesis and available treatments for TSP/HAM are reviewed. DEVELOPMENT: At least 20 million people are infected worldwide and 0.3-4% will develop TSP/HAM. Incidence in endemic areas is around 2 cases/ 100,000 inhabitants and year. The 50% of TSP/HAM patients suffer from clinical progression during their first ten years. Progression is associated with high proviral load and ager than 50 years at onset. HTLV-I proviral DNA and m-RNA load are significantly raised in TSP/HAM patients compared to asymptomatic carriers. This antigenic load activates T cells CD8+ specific for Tax-protein, which up-regulate pro-inflammatory cytokines. Corticoids, plasma-exchange, intravenous immunoglobulins, danazol, pentoxifilline, green-tea polyphenols, lactobacillus fermented milk, zidovudine, lamivudine, monoclonal antibodies (daclizumab), interferon, and valproic acid have been used in open trials in a small number of patients. Nevertheless, their clinical efficacy is limited. Interferon alpha and beta-1a have cytostatic properties and may cause a reduction in HTLV-I proviral load. CONCLUSIONS: High HTLV-I proviral load and an exaggerated pro-inflammatory cellular response are involved in the pathogenesis of TSP/HAM. No therapy has been conclusively shown to alter long-term disability associated with TSP/HAM. Multicentric clinical trials are necessary to assess long-term efficacy of interferon in TSP/HAM.

[Treatment of headaches among the Aborigines of Tierra de Fuego. A comparison with other anthropological studies]. / Tratamiento de las cefaleas entre los Aborígenes de Tierra de Fuego. Comparación con otros estudios antropológicos.

SUMMARY INTRODUCTION: Several different indigenous groups (Yamana, Selk'nam, Alacaluf, Haush) used to inhabit the Patagonian region of Tierra de Fuego, but are now extinct. AIM: To analyse the healing practices that these prehistoric aborigines used to treat headaches and to compare them with those observed in other anthropological studies. DEVELOPMENT: The article reviews the most important manuscripts from the end of the 19th century written by anthropologists and missionaries who were in contact with these peoples (Bridges, Hyades, Gusinde). The Yamana, or 'canoero' Indians, lived in the coastal areas and ate mostly seals and shellfish. The Selk'nam were nomadic hunter-gatherers who lived in the northern part of the Isla Grande. The Yekamush were the Yamana healers. The chief palliative treatments for pain were fasting, drinking cold water and the application of localised heat and massages. Headaches were one of the most prevalent conditions among the Yamana. Treatment for headaches consisted in hitting the patient's head with prickly chaura (Pernettya mucronata) leaves, which produces a small amount of bleeding, or the use of fresh nettle leaves, which were held in place with a headband. The Selk'nam used the term kwaketan to refer to the feeling of sadness with pain, while the term kwake meant 'illness'. Other common ways of treating headaches included ritual ceremonies with chanting, the detection of painful points, and the absorption and expulsion of the kwake. CONCLUSIONS: Headaches were one of the most frequent neurological pathologies among these prehistoric Fuegian aborigines, in line with the observations made in other transcultural studies conducted on present-day native cultures.

[Chronic central nervous system histoplasmosis in an immunocompetent patient]. / Histoplasmosis crónica del sistema nervioso central en un paciente inmunocompetente.

INTRODUCTION: Histoplasma capsulatum is an endemic fungus in America that may present as a lung self-limiting infection or be asymptomatic. Disseminated histoplasmosis can occur in cell-mediated immunity disorders and acquired immunodeficiency syndrome. Isolated central nervous system (CNS) histoplasmosis is uncommon, furthermore in immunocompetent patients. PATIENT: A 34 year old inmunocompetent male is reported. He presented with several pathogenic forms of neurohistoplasmosis: chronic meningitis, meningovascular histoplasmosis with stroke, acute myelopathy and chronic recurrent hydrocephalus. Other causes of chronic infectious meningitis were ruled out. Cerebrospinal flow (CSF) analysis showed an increased white cell count, hyperproteinorraquia and decrease of glucose levels. Brain magnetic resonance imaging (MRI) showed hydrocephalus and gadolinium enhancement of the meninges; a spinal cord MRI detected a cervical and thoracic myelopathy. A chronic unspecific inflammatory process and absence of granulomata were observed in a meninge biopsy. Electronic microscopy showed the presence of yeasts in the CSF. Histoplasma capsulatum was isolated in a specific culture from two consecutive CSF samples. The patient was treated with ev amphotericin B and fluconazol, plus 6 months of oral itraconazole. CONCLUSIONS: Isolated chronic CNS histoplasmosis may present as recurrent episodes of stroke, meningitis, myelopathy and hydrocephalus. CSF specific culture can help in the diagnosis.